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J ; APPLICATION FOR SANITATION PERMIT Permit No. _24(Complete in Duplicate) Date issued Applica+ion is hereby made to the San Joaquin Local Health-District for a permit to construct and install the work herein described, This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION ------ -`�� 7 `� -------- a.0 ._ ----- _ L = ; Owner's Name------------- �ni ------------------ - ---------------------- ----------- ne-------- ----- r_. -- -------•--- Address---------------------------------------------- = - P ry ------------ ---- ------•---••------ •--- -- 124 Contractor's Nama y ------- - -- -- •-----_----. Phone Installation will serve: Residence P� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑-} Number of living units_ :_ Number of bedrooms __ Number of baths :._/ Lot size ----------- - ---- - -------��1 ----------------- Water Supply.' Public system Comm unity system ❑ Private Depth to Water Table.-------- ft.` - Character of soll to a depth of 3 fee+- Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe.k Hardpan ❑ Previous Application Made: Yes JW No ❑ New Construction: Yes ❑ No) TYPE OF INSTALLATION-AND SPECIFICATIONS: F (No septic tank.or cesspool permitted if public sewer is available within 200 feet.)Zg Septic lank: Distance from nearest well_--. ._.Distance from foundation__ Mater'al No. of compartments----_.,-----; --.----5ize__.•--' XJC__ Liquid depth__.___ _-'---------Capacity_..._ _--- Dial Field: Distance from nearest wef!_- :-Distance from foundatDistance to nearest lot line---- Number of lines-------------- _--- -,----`Length of each:line-._.------.-6_d_-----...Width of french--------------� 1 ------ Yp � � Depth of filter. mate,nal___.____�8_ ___._Total length_ ____________!?-�_,--_----_--•-- T e of filter material__--_ __. � ' - Seepage' Pit: Distance to nearest well.___ '_,____.._____tl`_DistanCe from foundation_.................Distance.to nearest lot line._- _..____.._._ ❑ Number of its.T____ ...._.___ __.Lining material____..__ _--__:______.Size: Diameter............... ► - p - L g -----`-Depth--------------- ------------ Cesspool D �t istance from nearest well-... Distance from foundation ---------..Lining ------material.Sze.-Diameter �• - --- De th = _ `'_ L�igdid�Capacity=- gals. Priv - - ... Y:, r 4 =--_.__- Distance from nearest building- --------------------------- ------------ U ❑ Distance to nearest'lot line.-- Remodeling ine_____________________y' { stance from nearest yell________ _____'_.__ - ..emoa in and/or repairing descriL�e --=--------------------_------------------------------ ---------- ------------- ---- g / p 9 1 t ----------- •----------- - -'--------'i-""'-; -•- - -----•-----------------------¢...--------------------------------••-------------"------=-•----•----------•-----.._....-----------•------•----------------- I thereby certify:that'I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules ancl,regulations of the San Joaquin Local Health District. (Signed ------ � -•----------------------------------------(Owner and/or Contractor) ' Y:..... =n ------ -------------------------------- ---------••-------r-- [rtle) ---------- 1 (Plot plan, showing size of-lot, location 'of system in relation to wells, buildings,.etc., can be placed on reverse side). ` '..� FOR D PARTMENT USE ONLY APPLICATION ACCEPTED BY------- -----1-------- -= ---------- k-• -""' - ----------------------------- -- DATE'... - -----��- -----+ Vr I ED BY = ---------------= --------- -------- .......---- DATE--- REVBUILDING PERMIT ISSUED------------........ -•---------------- = ----------------------•------------------------ DATE----------- Alterations and/or recommendations:---- --- f --- ---•---- --------- F - Y --- f # # 2 ---------- ----.. ______________________ ________________________________________________________ ___,_______.__...______..___ -.----_-..---____. f � FINAL INSPECTION' BY:__ ' �` = == __ Date-'-----_- SAN JOAQUIN LOCAL HEALTH DISTRICT t 130 South American Street .300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100